title: Open adjunctive ziprasidone associated with weight loss in obese and overweight bipolar disorder patients.
abstract: OBJECTIVE
  To assess effectiveness and tolerability of open adjunctive ziprasidone for weight loss in obese/overweight patients with bipolar disorders (BD) in diverse mood states, taking weight gain-implicated psychotropic medications.
  
  
  METHODS
  22 obese and three overweight BD patients (20 female; 10 BD-I, 14 BD-II, 1 BD-NOS) with mean ± SD baseline body mass index (BMI) of 31.8 ± 2.5 kg/m2 received ZIP (mean final dose 190 ± 92 mg/day) for mean of 79.2 ± 23.2 days. Weight was assessed at six weekly and three biweekly visits. Subjects entered the study in diverse mood states. At baseline, 21 were taking second-generation antipsychotics, 7 lithium, and 1 valproate, which could be reduced/discontinued at investigators' discretion.
  
  
  RESULTS
  Weight and BMI decreased from baseline to endpoint by 4.5 ± 3.4 kg and 1.6 ± 1.2 kg/m2, respectively, at weekly rates of 0.37 kg and 0.13 kg/m2, respectively (all p < 0.00001). 48% of patients had at least 5% weight loss. Obesity rate decreased from 88% to 35% (p < 0.0001). Waist circumference decreased 1.6 inches (p = 0.0001). Overall, mood did not change. Patients with at least moderate baseline mood symptoms experienced significant mood improvement, despite 72% patients decreasing/discontinuing weight gain-implicated psychotropic medications. Seven patients discontinued ZIP early: 3 for weight loss inefficacy, and 1 each for viral gastroenteritis, loss of consciousness, pneumonia with hypomania, and lost to follow up.
  
  
  CONCLUSIONS
  Open adjunctive ziprasidone may be effective for weight loss in obese/overweight BD patients taking weight gain-implicated psychotropic medications. These preliminary data should be considered with caution due to the open uncontrolled design, small sample size, and brief duration.
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA. wangp0@stanford.edu
authors.forename: Po W
authors.initials: PW
authors.lastname: Wang
authors.forename: Shelley J
authors.initials: SJ
authors.lastname: Hill
authors.forename: Meredith E
authors.initials: ME
authors.lastname: Childers
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Chandler
authors.forename: Natalie L
authors.initials: NL
authors.lastname: Rasgon
authors.forename: Terence A
authors.initials: TA
authors.lastname: Ketter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy*; D001786:Blood Glucose / Q000187:drug effects; D015992:Body Mass Index; D004305:Dose-Response Relationship, Drug; D005215:Fasting; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000188:drug therapy*; D050177:Overweight / Q000150:complications / Q000188:drug therapy*; D010879:Piperazines / Q000627:therapeutic use*; D011446:Prospective Studies; D013844:Thiazoles / Q000627:therapeutic use*; D055105:Waist Circumference; D015431:Weight Loss / Q000187:drug effects*
chemical_list: D014150:Antipsychotic Agents; D001786:Blood Glucose; D010879:Piperazines; D013844:Thiazoles; C092292:ziprasidone